Clinical Presentation of EoE in Adults: a characteristic story!

Eosinophilic Esophagitis (EoE) is a chronic, progressive immune-mediated disorder characterized by various esophageal symptoms and a dense eosinophilic infiltration of the esophageal mucosa (≥ 15 eosinophils (eos)/high power field (HPF) or 60 eos/mm2). The diagnosis of EoE can be made after excluding other local or systemic causes ofesophageal eosinophilia. Additionally, EoE is frequently associated with a range of atopic comorbidities, such as asthma, allergic rhinitis, and atopic dermatitis, highlighting its complex immunological nature. Active EoE in adults can present with a wide spectrum of clinical symptoms that can vary in severity and intensity. Common symptoms include dysphagia or swallowing difficulties, particularly with solid foods, and food impaction, which often necessitates urgent endoscopic intervention. The precise and thorough endoscopic examination of the esophagus is an essential component in the diagnosis and monitoring of disease activity of EoE. While the appearance of the esophageal appearance can vary, several characteristic endoscopic findings are commonly observed. These encompass the following features: edema (E), ring formations (R), whitish exudates (E), furrows (F) and strictures (S). The presence or absence of these endoscopic signs should be recorded using the EREFS Scoring system to quantify the endoscopic severity of disease activity. In conclusion, EoE is a chronic inflammatory disorder of the esophagus characterized by a variety of clinical symptoms and distinct endoscopic features. Recognition of these clinical and endoscopic findings is crucial for the accurate diagnosis and management of EoE.